Introduction Since 2019 the Renal Department at Crosshouse University Hospital have introduced Future Care Plans (FCP) for targeted patients with end-stage renal failure to improve shared decision making and patient centred care. This is a review of the impact of these plans in the 53 patients who have since died to learn from their experiences.
Methods Key demographic features were compiled from the electronic record (clinical portal and SERPR) followed by qualitative analysis of ‘what matters to me’ and symptom burden. Measurable outcomes of time between FCP and death, number of hospital admissions, DNACPR discussions and preferred place of care were recorded.
Results Patients described an average of 3 symptoms with the most common being reduced mobility, fatigue, reduced appetite and pain. When asked what mattered to them, the most common responses were family (83%), quality of life (72%) and avoiding futile treatments (64%). The breadth of responses were grouped into social, medical, spiritual and recreational themes. There was an average of 8.8 months between FCP and death, with an average of 3.3 admissions over the last 12 months of life. All patients discussed escalation and resuscitation, with 94% having DNACPRs in place by time of death. 57% of patients said they would prefer to die at home but 55% of patients died in hospital and 45% died in community. Of those with a preference, 50% died in their preferred location.
Conclusions The introduction of FCPs has been a success in exploring and recording patient priorities and preferences. They have facilitated high rates of completed escalation plans but it remains challenging to quantify the impact they have had on quality of life. We will build on these lessons by encouraging early referral, involving the full MDT and ensuring ongoing conversations with our patients to prioritise what matters most to them.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.